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Imaging Findings of Kimura's Disease in the Soft Tissue of the Upper Extremity

¹ Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine.
² Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seong Nam, Gyeongi-Do, 463–707, Korea.
³ Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
⁴ Department of Radiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea.
⁵ Department of Radiology, Pusan Paik Hospital, Inje University College of Medicine, Pusan, Korea.
⁶ Department of Radiology, Yeungnam University College of Medicine, Gyeong-San, Gyeongsangbuk-Do, Korea.
⁷ Department of Radiology, Chonnam University College of Medicine, Gwangiu, 501-190, Korea.

View larger version (94K): [in a new window]   Fig. 1A. —15-year-old boy with palpable mass in right elbow for 4 years. Unenhanced axial CT scan shows partially defined soft-tissue mass with irregular fatty infiltration (arrow) indicating edema in medial subcutaneous tissue of right epitrochlear region.

View larger version (102K): [in a new window]   Fig. 1B. —15-year-old boy with palpable mass in right elbow for 4 years. Contrast-enhanced axial CT scan shows homogeneous enhancement of mass with internal vascular structure (arrow).

View larger version (121K): [in a new window]   Fig. 1C. —15-year-old boy with palpable mass in right elbow for 4 years. Axial T1-weighted spin-echo MR image (TR/TE, 500/17) reveals partially defined soft-tissue mass in medial subcutaneous tissue of epitrochlear region with internal flow voids.

View larger version (122K): [in a new window]   Fig. 1D. —15-year-old boy with palpable mass in right elbow for 4 years. Axial T2-weighted fast spin-echo MR image (3,500/102) shows high signal intensity of mass and surrounding soft-tissue edema.

View larger version (125K): [in a new window]   Fig. 1E. —15-year-old boy with palpable mass in right elbow for 4 years. Gadolinium-enhanced axial fat-suppressed T1-weighted spin-echo MR image (500/17) shows nearly homogeneous enhancement of mass without central necrotic portion.

View larger version (105K): [in a new window]   Fig. 2A. —21-year-old man with palpable mass in left elbow for 10 years. Axial T1-weighted spin-echo MR image (A) (TR/TE, 560/12) and axial T2-weighted fast spin-echo MR image (B) (3,120/60) show poorly defined mass in medial subcutaneous tissue of left epitrochlear region. Mass is isointense relative to muscle on T1-weighted spin-echo images and hyperintense relative to muscle on T2-weighted fast spin-echo images. Stranding in surrounding soft tissue and serpentine signal voids suggest vascular structures.

View larger version (117K): [in a new window]   Fig. 2B. —21-year-old man with palpable mass in left elbow for 10 years. Axial T1-weighted spin-echo MR image (A) (TR/TE, 560/12) and axial T2-weighted fast spin-echo MR image (B) (3,120/60) show poorly defined mass in medial subcutaneous tissue of left epitrochlear region. Mass is isointense relative to muscle on T1-weighted spin-echo images and hyperintense relative to muscle on T2-weighted fast spin-echo images. Stranding in surrounding soft tissue and serpentine signal voids suggest vascular structures.

View larger version (116K): [in a new window]   Fig. 2C. —21-year-old man with palpable mass in left elbow for 10 years. Gadolinium-enhanced axial (C) and coronal (D) T1-weighted spin-echo images obtained with fat saturation show good homogeneous enhancement of mass and surrounding soft-tissue edema. Note series of contiguous soft-tissue masses indicating chain of enlarged epitrochlear lymph nodes.

View larger version (100K): [in a new window]   Fig. 2D. —21-year-old man with palpable mass in left elbow for 10 years. Gadolinium-enhanced axial (C) and coronal (D) T1-weighted spin-echo images obtained with fat saturation show good homogeneous enhancement of mass and surrounding soft-tissue edema. Note series of contiguous soft-tissue masses indicating chain of enlarged epitrochlear lymph nodes.

View larger version (180K): [in a new window]   Fig. 3A. —Photomicrographs of Kimura's disease specimen in 20-year-old man. Photomicrograph shows hyperplastic follicles and diffuse eosinophilic infiltration. Follicles have prominent germinal center and also prominent mantles. Proliferation of postcapillary venules is also evident. (H and E, original magnification, x40)

View larger version (180K): [in a new window]   Fig. 3B. —Photomicrographs of Kimura's disease specimen in 20-year-old man. Photomicrograph shows heavy eosinophilic infiltration forming eosinophilic abscesses and prominent vasculature. Vessels are postcapillary venules with prominent endothelial cells. (H and E, x200)

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